KUALA LUMPUR (Sept 20): The Government has to make tough decisions and boost efforts to build and future-proof the country's healthcare infrastructure towards sustainability and resiliency, said the Galen Centre for Health and Social Policy.

In a statement on Tuesday (Sept 20), Galen Centre chief executive officer Azrul Mohd Khalib called for increases in commitment and investments in five key areas: healthcare financing; non-communicable diseases; public health emergency preparedness and response; reproductive health; and aged care.

He said that for too long, conversations concerning healthcare have been dependent on, hampered and restricted by issues of affordability, rather than centred around meeting current needs and ongoing challenges of a growing population and economy of a country making the transition from an upper-middle-income to high-income economy.

"Decisions are often based on what we can afford rather than finding out what we need, how much money is available, and finding solutions to bridge those funding gaps.

“This is also not just about having more funding, but also how that money is spent. We need to change the way we look at health as an investment, not expenditure,” he said.

Azrul recommended that the Government remove the RM1 charge for outpatient care and RM5 for specialist care at Ministry of Health (MOH) facilities.

He said these charges sustain the misrepresentation that healthcare in Malaysia is somehow cheaper at government facilities.

“They are also inadequate for meaningful cost recovery, and mislead the public regarding the true cost of healthcare.

“We believe that these charges act as a barrier, and should be removed to facilitate future reforms of healthcare financing," he said.

Azrul said Malaysia is in a non-communicable disease (NCD) crisis.

“One of these NCDs is diabetes. There are almost four million people living with diabetes in this country,” he said.

Azrul said a recent MOH-World Health Organization report showed that annual direct healthcare spending on this disease is RM4.38 billion, and is the highest compared to cardiovascular disease (CVD) and cancer.

“For every ringgit spent on the three NCDs, 45 sen goes to diabetes, 41 sen goes to CVD, and 14 sen to cancer. 

“We propose reducing subsidisation for diabetic treatments and introducing co-payments of up to 30% of actual cost.

“People must care and take charge of their own health. It will also help reduce wastage of subsidised medication," he stressed.

Azrul said Malaysia has been deemed as being ill-prepared to deal with the needs and consequences of a growing ageing population.

He said aged and long-term care facilities and relevant essential services remain limited, mostly confined to urban centres, and concentrated in private providers.

"There is a lack of clarity for which Ministry should be responsible. There is unsustainable dependence on informal care.

“As a result, this issue has suffered tremendous decline, resulting in many older individuals vulnerable to neglect, substandard care, and even abuse,” he said.

Azrul added that the Government needs to immediately make improving aged and long-term care a priority to be addressed in the upcoming Budget 2023.

“Rather than depend on unfunded and unsustainable entitlements, it may be necessary to introduce a national insurance scheme for those above the age of 40 specifically to fund aged and long-term care.

“Ad hoc approaches will not be sufficient or sustainable," he said.